DeHerrera M

Introduction: The Commission on Cancer (COC), the New Mexico VA Health Care System (NMVAHCS) accrediting body for cancer care, mandates 25% of nurses maintain oncology nurse certification (OCN) to validate competency. However, the NMVAHCS remains deficient: threatening facility ability to maintain accreditation. Per the Oncology Nursing Certification Corporation, Albuquerque maintains 160 OCNs. However, 50% have retired and the remaining 50% are over 52. Leaving approximately 40 OCN nurses in a population of 500,000. This problem was not only a NMVAHCS problem, but a community problem: affecting quality of oncology care.

Problem: Not only is certification required for COC accredited facilities, it represents validation of expertise and skill set. Validation serves to build trust of Veterans, enables superior clinical judgment, and contributes to improved outcomes. With the Choice Program, many Veterans can leave the VAHCS. Certification serves to build necessary confidence required to keep Veterans within the VAHCS.

Methods: Barriers prohibiting certification were identified through survey of oncology nurses. Nurses reported fear related to failure, study material costs, exam fees, lack of mentors, and lack of internal leadership encouragement and support as barriers of certification. Funding was sought to provide a review course for 40 nurses, study guides, reimbursement of course and exam fees and held June 2017 in Albuquerque, New Mexico. A second review course, held during the 2017 AVAHO meeting, was conducted for another 24 nurses. The courses aimed to build confidence and decrease barriers. Both exceeded capacity.

Results: As a result of the Albuquerque course, VISN 22 and non-VA nurses attended from several states. Each received
a 30% reduction in exam fees and were eligible for exam reimbursement after passing: 50% of attendees are now OCNs.

The AVAHO course, to date, has resulted in an additional 2 OCNs, 2 certification renewals, and an additional 5 are registered for the exam. Those not taking the exam cite lack of leadership support and encouragement as the main
barrier.

Implications: Certification validates care provided and builds Veterans trust: necessary with Choice. Facilities that retain a strong foundation of OCNs, mentor staff, and maintain leadership support remain more apt to produce and sustain certified nurses. Therefore, leadership buy-in remains essential.

Introduction: The Commission on Cancer (COC), the New Mexico VA Health Care System (NMVAHCS) accrediting body for cancer care, mandates 25% of nurses maintain oncology nurse certification (OCN) to validate competency. However, the NMVAHCS remains deficient: threatening facility ability to maintain accreditation. Per the Oncology Nursing Certification Corporation, Albuquerque maintains 160 OCNs. However, 50% have retired and the remaining 50% are over 52. Leaving approximately 40 OCN nurses in a population of 500,000. This problem was not only a NMVAHCS problem, but a community problem: affecting quality of oncology care.

Problem: Not only is certification required for COC accredited facilities, it represents validation of expertise and skill set. Validation serves to build trust of Veterans, enables superior clinical judgment, and contributes to improved outcomes. With the Choice Program, many Veterans can leave the VAHCS. Certification serves to build necessary confidence required to keep Veterans within the VAHCS.

Methods: Barriers prohibiting certification were identified through survey of oncology nurses. Nurses reported fear related to failure, study material costs, exam fees, lack of mentors, and lack of internal leadership encouragement and support as barriers of certification. Funding was sought to provide a review course for 40 nurses, study guides, reimbursement of course and exam fees and held June 2017 in Albuquerque, New Mexico. A second review course, held during the 2017 AVAHO meeting, was conducted for another 24 nurses. The courses aimed to build confidence and decrease barriers. Both exceeded capacity.

Results: As a result of the Albuquerque course, VISN 22 and non-VA nurses attended from several states. Each received
a 30% reduction in exam fees and were eligible for exam reimbursement after passing: 50% of attendees are now OCNs.

The AVAHO course, to date, has resulted in an additional 2 OCNs, 2 certification renewals, and an additional 5 are registered for the exam. Those not taking the exam cite lack of leadership support and encouragement as the main
barrier.

Implications: Certification validates care provided and builds Veterans trust: necessary with Choice. Facilities that retain a strong foundation of OCNs, mentor staff, and maintain leadership support remain more apt to produce and sustain certified nurses. Therefore, leadership buy-in remains essential.

Introduction: The Commission on Cancer (COC), the New Mexico VA Health Care System (NMVAHCS) accrediting body for cancer care, mandates 25% of nurses maintain oncology nurse certification (OCN) to validate competency. However, the NMVAHCS remains deficient: threatening facility ability to maintain accreditation. Per the Oncology Nursing Certification Corporation, Albuquerque maintains 160 OCNs. However, 50% have retired and the remaining 50% are over 52. Leaving approximately 40 OCN nurses in a population of 500,000. This problem was not only a NMVAHCS problem, but a community problem: affecting quality of oncology care.

Problem: Not only is certification required for COC accredited facilities, it represents validation of expertise and skill set. Validation serves to build trust of Veterans, enables superior clinical judgment, and contributes to improved outcomes. With the Choice Program, many Veterans can leave the VAHCS. Certification serves to build necessary confidence required to keep Veterans within the VAHCS.

Methods: Barriers prohibiting certification were identified through survey of oncology nurses. Nurses reported fear related to failure, study material costs, exam fees, lack of mentors, and lack of internal leadership encouragement and support as barriers of certification. Funding was sought to provide a review course for 40 nurses, study guides, reimbursement of course and exam fees and held June 2017 in Albuquerque, New Mexico. A second review course, held during the 2017 AVAHO meeting, was conducted for another 24 nurses. The courses aimed to build confidence and decrease barriers. Both exceeded capacity.

Results: As a result of the Albuquerque course, VISN 22 and non-VA nurses attended from several states. Each received
a 30% reduction in exam fees and were eligible for exam reimbursement after passing: 50% of attendees are now OCNs.

The AVAHO course, to date, has resulted in an additional 2 OCNs, 2 certification renewals, and an additional 5 are registered for the exam. Those not taking the exam cite lack of leadership support and encouragement as the main
barrier.

Implications: Certification validates care provided and builds Veterans trust: necessary with Choice. Facilities that retain a strong foundation of OCNs, mentor staff, and maintain leadership support remain more apt to produce and sustain certified nurses. Therefore, leadership buy-in remains essential.

Problem: With improved treatment modalities, cancer has become a chronic disease. However, without appropriate surveillance Veteran outcomes fall short of expected survival rates.

Extended longevity increases the likelihood of recurrence. The potential for development of secondary diseases or other iatrogenic disorders caused by cancer treatments also increases over time. Therefore, appropriate surveillance remains essential for detection of early complications: improving Veterans outcomes and value.

Background: Commission on Cancer accreditation requires provision of a survivorship care plan (SCP): retroactive disease and treatment information abstracted from the medical record provided at the end of treatment. The intent aims to increase communication of care as patients transition from oncology specialists. However, waiting until the completion of care fails to provide value for our Veteran or improve quality outcomes during the cancer treatment trajectory and active surveillance phase.

Our Veteran population remains stoic, ignoring symptoms requiring medical attention until symptoms become unbearable. By this time, disease progression is usually advanced. Veterans present to the emergency room in late stages of disease requiring emergent surgeries or chemotherapeutic treatments. Regrettably, such costly interventions lack extended value and only serve to stabilize or palliate symptoms: leading to poor overall Veteran outcomes and litigation liabilities for the facility.

Methods: The New Mexico VAHCS process remains different: a proactive approach, beginning at diagnosis. Imbedded health factors in the SCP, capture the provider’s individualized plan for each Veteran: identifying when surveillance care is due. Utilizing technology, the Central Data Warehouse captures this plan and populates the Cancer Dashboard. Previously, monitoring such plans remained tedious: relying on Excel spreadsheets. However, the creation of the Dashboard allows proactive identification of Veterans needing care.

Results: This system has enabled trusting relationships with our Veterans. Since implementation, the no-show rate of Veterans living with cancer has decreased from 53% to 0.09%: enabling timely care.

Conclusions: The use of health factors in proactive formats improves quality care and provides data: offering information to monitor quality metrics and establish benchmarks: improving the delivery of evidence-based care. Automation prevents loss to follow-up, decreases duplication of services, prevents omissions, and delivery of unnecessary care.

Problem: With improved treatment modalities, cancer has become a chronic disease. However, without appropriate surveillance Veteran outcomes fall short of expected survival rates.

Extended longevity increases the likelihood of recurrence. The potential for development of secondary diseases or other iatrogenic disorders caused by cancer treatments also increases over time. Therefore, appropriate surveillance remains essential for detection of early complications: improving Veterans outcomes and value.

Background: Commission on Cancer accreditation requires provision of a survivorship care plan (SCP): retroactive disease and treatment information abstracted from the medical record provided at the end of treatment. The intent aims to increase communication of care as patients transition from oncology specialists. However, waiting until the completion of care fails to provide value for our Veteran or improve quality outcomes during the cancer treatment trajectory and active surveillance phase.

Our Veteran population remains stoic, ignoring symptoms requiring medical attention until symptoms become unbearable. By this time, disease progression is usually advanced. Veterans present to the emergency room in late stages of disease requiring emergent surgeries or chemotherapeutic treatments. Regrettably, such costly interventions lack extended value and only serve to stabilize or palliate symptoms: leading to poor overall Veteran outcomes and litigation liabilities for the facility.

Methods: The New Mexico VAHCS process remains different: a proactive approach, beginning at diagnosis. Imbedded health factors in the SCP, capture the provider’s individualized plan for each Veteran: identifying when surveillance care is due. Utilizing technology, the Central Data Warehouse captures this plan and populates the Cancer Dashboard. Previously, monitoring such plans remained tedious: relying on Excel spreadsheets. However, the creation of the Dashboard allows proactive identification of Veterans needing care.

Results: This system has enabled trusting relationships with our Veterans. Since implementation, the no-show rate of Veterans living with cancer has decreased from 53% to 0.09%: enabling timely care.

Conclusions: The use of health factors in proactive formats improves quality care and provides data: offering information to monitor quality metrics and establish benchmarks: improving the delivery of evidence-based care. Automation prevents loss to follow-up, decreases duplication of services, prevents omissions, and delivery of unnecessary care.

Problem: With improved treatment modalities, cancer has become a chronic disease. However, without appropriate surveillance Veteran outcomes fall short of expected survival rates.

Extended longevity increases the likelihood of recurrence. The potential for development of secondary diseases or other iatrogenic disorders caused by cancer treatments also increases over time. Therefore, appropriate surveillance remains essential for detection of early complications: improving Veterans outcomes and value.

Background: Commission on Cancer accreditation requires provision of a survivorship care plan (SCP): retroactive disease and treatment information abstracted from the medical record provided at the end of treatment. The intent aims to increase communication of care as patients transition from oncology specialists. However, waiting until the completion of care fails to provide value for our Veteran or improve quality outcomes during the cancer treatment trajectory and active surveillance phase.

Our Veteran population remains stoic, ignoring symptoms requiring medical attention until symptoms become unbearable. By this time, disease progression is usually advanced. Veterans present to the emergency room in late stages of disease requiring emergent surgeries or chemotherapeutic treatments. Regrettably, such costly interventions lack extended value and only serve to stabilize or palliate symptoms: leading to poor overall Veteran outcomes and litigation liabilities for the facility.

Methods: The New Mexico VAHCS process remains different: a proactive approach, beginning at diagnosis. Imbedded health factors in the SCP, capture the provider’s individualized plan for each Veteran: identifying when surveillance care is due. Utilizing technology, the Central Data Warehouse captures this plan and populates the Cancer Dashboard. Previously, monitoring such plans remained tedious: relying on Excel spreadsheets. However, the creation of the Dashboard allows proactive identification of Veterans needing care.

Results: This system has enabled trusting relationships with our Veterans. Since implementation, the no-show rate of Veterans living with cancer has decreased from 53% to 0.09%: enabling timely care.

Conclusions: The use of health factors in proactive formats improves quality care and provides data: offering information to monitor quality metrics and establish benchmarks: improving the delivery of evidence-based care. Automation prevents loss to follow-up, decreases duplication of services, prevents omissions, and delivery of unnecessary care.